Prevalence of esophageal cancer during the pretreatment of hypopharyngeal cancer patients: Routinely performed esophagogastroduodenoscopy and FDG-PET/CT findings

Figures & data

Table I. Characteristics and study results of 33 HPC patients.

			Hypopharyngeal cancer		Esophageal cancer
Case No	Age	Sex	cTNM	Clinical stage	Esophageal cancer diagnosis	No. of lesions	EGD findings (depth of invasion)	FDG-PET/CT findings	SUVmax	cTNM	Clinical stage	Treatment (esophageal cancer)
1	69	M	T2M2cM0	IVA	SCC	1	T1a	Negative		T1aN0M0	IA	EMR
2	69	M	T1N0M0	I	SCC	3	T3 T1b T1a	Negative Positive Negative	10.8	T3N0M0	IA	Operation
3	72	M	T2N2bM0	IVA	SCC	1	T1a	Negative		T1aN0M0	IA	EMR
4	71	M	T3N0M0	III	SCC	1	T1a	Negative		T1aN0M0	IA	EMR
5	53	F	T1N0M0	I	SCC	2	T3 T1a	Positive Negative	10.1	T3N1M0	IIIA	Operation
6	56	M	T3N2cM0	IVA	SCC	1	T1a	Negative		T1aN0M0	IA	EMR
7	56	M	T2N0M0	II	SCC	1	T1a	Negative		T1aN0M0	IA	Unknown
8	75	M	T1N0M0	I	SCC	2	T1a T1a	Negative Negative		T1aN0M0	IA	EMR
9	40	M	T1N0M0	I	SCC	4	T1a T1a T1a T1a	Negative Negative Negative Negative		T1aN0M0	IA	EMR
10	65	M	T2N1M0	III	SCC	2	T3 T1a	Positive Negative	8.4	T3N2M0	IIIB	Operation
11	79	M	T2N1M0	III	SCC	1	T3	Positive	33.2	T3N2M0	IIIB	Unknown
12	52	M	T2N1M1	III	SCC	3	T3 T1a T1a	Positive Negative Negative	10.4	T3N0M0	IIA	CRT
13	76	M	T2N1M0	III	SCC	2	T1a T1a	Negative Negative		T1aN0M0	IA	EMR
14	68	M	T2N1M0	III	SCC	1	T1b	Equivocal	3.8 （diffuse）	T1bN0M0	IA	Chemotheraphy
15	49	M	T2N2cM0	IVA	SCC	2	T1a T1a	Negative Negative		T1aN0M0	IA	EMR
16	69	M	T4bN2cM0	IVB	SCC	1	T1a	Negative		T1aN0M0	IA	No treatment
17	71	M	T4aN2cM0	IVA	SCC	1	T1b	Positive	4.4	T1bN1M0	IIB	CRT
18	69	M	T2N2bM0	IVA	Negative	0		Negative
19	73	M	T4aN2bM0	IVA	Negative	0		Negative
20	51	M	T2N2bM0	IVA	Negative	0		Negative
21	52	M	T2N2bM0	IVA	Negative	0		Negative
22	67	M	T1N2cM0	IVA	Negative	0		Negative
23	78	F	T2N1M0	III	Negative	0		Negative
24	65	M	T3N2bM0	IVA	Negative	0		Negative
25	56	M	T1N2bM0	IVA	Negative	0		Negative
26	73	M	T2N0M0	II	Negative	0		Negative
27	66	M	T2N0M0	II	Negative	0		Negative
28	66	M	T4aN3M1	IVC	Negative	0		Negative
29	62	M	T2N0M0	II	Negative	0		Negative
30	77	M	T2N0M0	II	Negative	0		Negative
31	77	F	T2N0M0	II	Negative	0		Negative
32	65	M	T1N2aM0	IVA	Negative	0		Negative
33	56	F	T1N2bM0	IVA	Negative	0		Negative

CRT, chemoradiotheraphy; EMR, endoscopic mucosal resection; SCC, squamous cell carcinoma.

Figure 1. A. Maximum intensity projection (MIP). B,C. Transaxial PET/CT. A 79-year-old man (Case 11). An FDG-PET/CT image shows focal FDG uptake on the right side of the hypopharynx (SUVmax, 13.4). An additional FDG uptake is observed from the lower thoracic to abdominal esophagus (SUVmax, 33.2); this uptake was confirmed to represent an esophageal squamous cell carcinoma (T3).

Figure 2. A. Maximum intensity projection (MIP). B,C. Transaxial PET/CT. A 68-year-old man (Case 14). An FDG-PET/CT image shows focal FDG uptake on the left side of the hypopharynx (SUVmax, 4.4), bilateral neck lymph nodes (SUVmax, 8.2), and the left lower jaw (SUVmax, 18.1), which was already identified as a mandibular neoplasm. The additional detection of FDG uptake (arrow) was observed from the upper to middle thoracic esophagus (SUVmax, 3.8). This case was considered to possibly reflect an inflammatory change, such as reflux esophagitis, because the distribution of the FDG uptake was diffuse, rather than focal; thus, we diagnosed the FDG-PET/CT image as equivocal. The uptake was subsequently confirmed to represent an esophageal cancer (T1b) based on the EGD findings.

Table II. The distribution of the clinical T classifications of esophageal cancer lesions.

T classification of esophageal cancer	No. of lesions diagnosed by EGD	No. of FDG-PET/CT positive lesions	No. of FDG-PET/CT negative lesions
T1a	21	0	21
T1b	3	1	2
T2	0	0	0
T3	5	5	0
T4	0	0	0
Total	29	6	23